Thursday, February 09, 2006

Overtime

Not been at work much this week as it’s my week off, hence the lack of posts.  I have done a couple of overtime shifts though.

The more interesting calls came on the second shift.  I got a call to a bus, where the MDT said there was a 14 year old male vomiting and had a head injury after being attacked.  It turned out he’d been in a fight an hour before and had been hit in the head a few times.  He was now pale, had vomited, felt dizzy and was complaining of a thumping headache and neck pain.  I suspected he was suffering from concussion after the head blows.
The crew arrived shortly after me, and we put a collar on to stabilise his neck, laid him onto a spinal board just as a precaution, and the crew popped him off to hospital.

The second was given as a 74 year old female ?suspended (LAS slang for possibly in cardiac arrest.)  I arrived to find her sitting on the sofa, cyanosed (blue), and confirmed she wasn’t breathing.  She was still warm, so I quickly laid her on the floor and attached the defibrillator pads.  While I was doing this, I asked her husband what had happened.  He said they had been watching Neighbours on TV, he’d heard her give a loud sigh and then she stopped breathing.  (I managed to refrain from saying that Neighbours makes me feel like that too!)  He also said she had a heart condition, and that it was atrial fibrillation (AF).

Atrial Fibrillation is quite common in older people, and what happens is that the two chambers that receive the blood back from the rest of the body stop beating properly and just quiver.  This doesn’t normally cause a huge problem as up to 70% of the blood that is transferred into the ventricles to be pumped back out again is done so by gravity.

The AED (Automated External Defibrillator) showed me that the patient was in VF (Ventricular Fibrillation – like AF but the ventricles quiver – means that the heart has stopped pumping and if you could actually see the heart while it was doing it, it would look like a bag of worms.) VF is a shockable rhythm.  

As the defib charged to deliver the electric shock, I explained to the husband what I was doing and that he would see his wife twitch as I delivered an electric shock to try to re-start her heart.  I pressed the button and she twitched.  I found myself holding my breath as I watched the screen to see if it was successful.  It wasn’t – her heart was still in VF.  I delivered a second shock.  This time she went into asystole – flat line.  At this point, the crew turned up and we started CPR.  After a minute, the AED announced that it was re-analysing the patient’s heart rhythm and that we were not to touch the patient.  She had gone into VF again.  We gave 3 shocks this time, and although still in VF, we continued with another minute’s CPR.

In between salvos of shocks, we got her out to the ambulance, and I went with the crew in the back of the ambulance to help with CPR.  We gave 14 shocks in total, and she had another two in the hospital.  After we’d been trying to revive her for an hour, the doctors decided we’d done all we could.  She had been in cardiac arrest for far too long now and the chance of survival was minimal.  Returning to normal life was going to be virtually impossible as her brain had been starved of an adequate oxygen supply for far too long.
CPR is only 20% as effective as a normal heart beat.

Her husband knew she was dead.  He had offered to help us give her the “kiss of life” in the ambulance but I assured him that we were doing all we could for her.  He was glad she’d just “dropped dead” as he put it, as it meant she hadn’t suffered.  She’d just closed her eyes, gave a sigh, and passed away peacefully.

It was just her time to go.

8 Comments:

Blogger Spike said...

After reading several emergiblogs I've come to recognise that as a good death. Hope I go that quick.

4:02 am  
Blogger Learning Nursing said...

not very peacefull though - having hundreds of joules of electricity passed through your body (14 times) drugs pumped into your veins and probably tubes stuck in your throat.

8:56 am  
Anonymous swpete said...

Yes, it was her time to go, but you spoilt it, depriving her of all dignity with your futile interference. Shame on the lot of youse! Can't you just let people go naturally?

9:41 am  
Anonymous Anonymous said...

Would you say the same thing for a year old child?i think not. Why should age come into it? yes she was old and manys the time i have worked on elderly people deep down thinking whats the bloody point they have died peacefully, do you know how it grates me to deliver a shock or break another rib?? Sorry for ranting and i dont know if you're LAS or not but that kind of attitude IMHO is wrong. We have guidelines and protocols to work to, if someone is suspected of being down less than 20 mins we have to work on them regardless (unless they have a DNR) this old girl even had a shockable rhythm! try explaining to a coroner why you didnt bother. Would you have the same attitude to a 25 yr old male left severly disabled by an rta?? think about it.

SWbod x

12:55 pm  
Anonymous LAS-DSO! said...

I am disgusted at your lack of compassion, this lady you are talking about like a piece of meat is someone's wife and mother, there is no place for little self gratifying 'Neighbours' jokes at her expence. You seem to have great delusions of grandeur. If I find out who you are we will have serious words. Please be very careful how you write in future as you are being watched very closely.
Are you sure this job is really for you as I hear St Johns are recruiting new butchers as we speak. Speak soon!

8:17 am  
Anonymous Lady Grey said...

As an old lady myself I love Neighbours and now I am rather concerned. My son says I can no longer watch my favourite soap as the side effects could be fatal. I eagerly await your advice on this matter as you are no doubt an expert. I find sometimes I get palpitations and incontinence when those leath toned young Australian boys take their shirts off and flex their muscles. Just writing this e-mail is causing me moisture issues. Must retire to the bathroom now for a flannel rub down and a Gin and tonic darling.

8:31 am  
Anonymous Anonymous said...

Theres always one isnt there.....

Unfortunately in this case there is atleast 2......

SWbod xx

1:52 pm  
Anonymous Anonymous said...

A nice story, well told.
You did the correct thing.

6:34 am  

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